Study reveals a broad shift away from overtreatment of low-risk prostate cancer

An analysis of United States data reveals a broad shift away from overtreatment of low-risk prostate cancer. The analysis published by Wiley online in CANCER, a peer-reviewed journal of the American Cancer Society, indicates a shift toward surveillance in response to concerns of overdiagnosis and overtreatment that have hindered screening in the recent past.

During the 2010s, recommendations supporting prostate-specific antigen–based screening for prostate cancer wavered due to growing concerns about the use of unnecessary treatment for slow-growing, localized cancers that posed no threat to patients' lives. As a result, guidelines supported active surveillance for such low-risk prostate cancer.

To assess the extent to which this shift has translated into reduced treatment among patients, investigators analyzed localized prostate cancer cases across the U.S. in the Surveillance, Epidemiology, and End Results Program (SEER; 2010–2023), the Veterans Affairs health system (VA; 2010–2024), and the Michigan Radiation Oncology Quality Consortium (MROQC; 2021-2025).

The researchers found that since 2010, low-risk prostate cancer has become less common at the time of diagnosis, while patients diagnosed with low-risk cancer increasingly avoid treatment. Specifically, low-risk prostate cancer at diagnosis declined from 28.8% to 24.0% in SEER and from 32.3% to 21.9% in the VA. Among patients diagnosed with low-risk cancer, receipt of neither radiation nor prostate removal increased from 33.6% to 83.4% in 2023 in SEER and from 51.6% to 96.3% in 2024 in the VA. Among 207,196 patients treated with radiation for localized prostate cancer, the proportion with low-risk disease declined from 33.7% to 6.5% in SEER and from 22.9% to 2.0% in the VA. In the more recent MROQC cohort, the proportion remained low, 2.8% to 4.2%, between 2021 and 2025.

These data reflect broad changes in how prostate cancer is diagnosed and managed in the United States. We are seeing a moderate decline in the amount of low-risk prostate cancer being diagnosed, likely reflecting more magnetic resonance imaging use in screening. Moreso however, we are seeing that most of the low-risk prostate cancer is now being appropriately observed and not treated. This is a big win for patients because it means patients are avoiding the harms of unnecessary treatment for cancers that are unlikely to ever affect them."

Steven M. Monda, MD, MSCI, lead author, University of Michigan